Economists and bulimia
I can’t remember the last time I saw “economist” and “bulimia” in the same headline — I usually don’t put the two together. However, this article (Eating-Disorders Experts Challenge Economists’ Conclusions About Bulimia) made some pretty interesting statements:
- Bulimia Nervosa (BN) is an addiction rather than an eating disorder
- Black females are 50% more likely to be bulimic than white females
- “Bulimic behavior” is less likely among wealthier, better-educated families.
You should definitely read the article, but I have a couple of things to add to these points:
1. BN is an addiction
I always compare eating disorders and addictions — but I still wouldn’t put BN and alcoholism in the same category. There are several key differences:
- Lack of an addictive substance: Addictions require you to be, well, addicted to something — alcohol, opiates, cocaine, etc. With bulimia, there’s no addictive substance. I don’t think you can even argue “food” as the addictive substance.
- No healthy use for symptoms: Occasional purging is not okay or normal. I’d argue that anyone who purges has an eating disorder (at least on some level). However, there are appropriate uses for alcohol, opiates, and even cocaine.
- Goals of treatment: With addictions, the goal is to abstain from the addictive substance. However, you can’t abstain from food (maybe from purging, but again, that’s only half of it).
- Psychopathology: “Addict thinking” is not really the same as “eating disorder thinking.” Similar — but not the same.
2. BN more common in black females
I don’t have much to say about this one, except that I’m skeptical. I don’t think EDs are limited to certain races, but I think that if you looked at the cultural make-up of treatment centers, you’d find this claim to be false. Yes, this is measuring those in treatment vs. BN prevalence — and there is likely a difference — but not a 30%+ difference!
3. Bulimia less common in upper-class families
Similarly, I don’t think that BN has socioeconomic limitations…
If for no other reason, the article at least challenges the many ED stereotypes. It’s curious to me that a) there is no reference to males with eating disorders and b) the study is unique to bulimia. I’d be interested to see if authors found similar results with anorexia.
Regarding point #1 under item #1, there could be endogenous substances that cause bulimia to be analogous to an addiction. I know that for anorexia, starvation and overexercise induce the brain to release endorphins, which essentially bind the same receptors as morphine and similar drugs, and I think b/p can have the same effect.
#2 is interesting, but asserting racial differences like that is always very tricky due to sampling bias. I agree with you, skepticism definitely warranted there.
Hi Cammy,
I think that there is some physical addiction to restricting, bingeing, and purging… but when I was thinking “addictive substance,” I was thinking about something that you could abstain from. With alcoholism and drug addictions, there is an actual substance that you can pinpoint as causing the addiction. If you labeled everything that causes the brain to release more endorphins an addiction, then positive thinking, chili peppers, overwhelming emotions, and UV light would all be considered addictions.
I agree that there are physical, addictive components of eating disorders, but can’t pinpoint the addiction to an outside substance.
I have been thinking about this a lot lately as we do our substance abuse until in medical school. We watched a video interview from a former med student describing his struggle with cocaine addiction, and I could relate to a lot of it, substituting in eating disorder for cocaine. For example, he talked about how he would set all this “rules” for himself such as “I wont use drugs tomorrow, the next day I will do it once and then wait two days etc.” I find myself setting similar rules when it comes to food “tomorrow I will only eat X amount, the next day I have an exam so X amount is ok that day” etc. In addition, our professors keep stressing that addiction really has nothing to do with physiological withdrawl, but has everything to do with loss of control, doctor shopping for drugs etc (which is very different from what the article says, that “the core component in medicine and psychology is physiological withdrawal”). Anyway, again I think there are some parallels to eating disorders there – it isn’t so much about the physiological symptoms, but about the mentality, depression, feeling out of control, feeling like your life revolves around food etc.
However, I do also agree that there are some big differences, like you pointed out. You can’t abstain from food, whereas the model for addiction recovery is to abstain. Also, as I am realizing from these lectures, there is a really good understanding of the exact biology that occurs in addiction and when addicts have cravings, but there really isn’t good research on this in eating disorders. It would be interesting to see if people who are bulimic, for example, show activation of the same brain circuits when they see binge food as addicts have when they see drugs. That to me would be very convincing of a relationship between the two.
I’d like to argue that certain types of food or things found in food (sugar, carbs, etc.) are addictive substances, and people do abstain from them. Some people simply cut out sugar because they are truly addicted, they can’t have any because it triggers them to binge.
Ah, I see what you meant about an addictive substance. It’s there, but you can’t go cold turkey, although you can quit behaviors that intentionally boost it. This is basically what drugs are, except on a huger scale, because they wouldn’t affect us if we didn’t have endogenous receptors that respond to them. But having a condition that is exacerbated by less explicit behaviors (purging versus snorting powder, working out versus shooting up) can make it, arguably, even more difficult to overcome than an external drug, because the behavior is easier to rationalize away.
By the way, I think that item #1 is just misguided overall, if it categorically says BN isn’t an eating disorder. With mental illness it is very risky to put things in black and white, someone’s issues can have attributes of both an ED and an addiction, and where do you draw the line?
Thanks for this thought-provoking post!
BL: Your point about research and understanding the biology of addiction was really good — hadn’t thought about that.
Jill: The sugar thing may very well be true, but with bulimia, it’s not just the food — purging is very much of the addiction.
Cammy: I also think it’s weird to classify bulimia as an addiction, and not anorexia or binge-eating disorder? Granted the study was focused on bulimia, but I don’t think you can just ignore the ED continuum…
Thanks for your comments!!
yes, which is why bulimia is obviously an ED not just an addiction
(I’ve thus far been able to “ween” myself off the addiction of purging, most of the time, but still have trouble with the food-chemical-addictions that cause binges.)
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